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BOAAD O 'TMUSTERS ,{y JOAQUIN LOCAL HEALTH C <br /> Al Crow,Pres. `J��r+� SEIiYiHC <br /> Earl yjoyei,viceS@C Pres 1604 East HaZelton Avenue <br /> Tommy Joyce,�,y_ San Joaquin Counry, <br /> James F,Culbertaon Stockton, California 95205 City Of Manteca <br /> John 0.Mast,M.O. City of Escalon <br /> Virginia Mathews JOC,t KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFIeZR City of Lodi <br /> City of Ripon <br /> Thomas Schubert,O,V,M. ENVIRONMENTAL HEALTH DIVISION City of Tracy <br /> Daphne Shaw <br /> Harvey Williams,Ah.0, (200) 468-3420 $an Joaquin County <br /> City or Stockton <br /> A U T W C)F;;� :r Z T Ran Joaquin County <br /> - <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> -- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,- THE UNDERSIGNED OWNER AND/©P, rOPERATOR OF THE PROPERTY ANI}/OF FACILITY' <br /> LS Y <br /> LOCATED AT Arr&'16 -t-, '4a1r e." � �o <br /> (STREET Ab.�r � d.�;��eb <br /> HERESY AUTHORIZE in g� e.'lor 0- LTANT) <br /> rcrrr) <br /> TO RELEASE ANY ANIS ALL ANALYTICAL.RSRESULTS, GEOTECHNICAL. DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: Q tn1 r�IlL L �5f ryi �fi <br /> dJf APP(!CA$I£) <br /> OWNER/OPERATOR; <br /> (P(EASE PRINT) dFlT(£) <br /> ADDRESS: <br /> uAI(I88 ADDRESS) <br /> (0111) (STATE) (ZIP) <br /> PHONE: < ? <br /> DATE: <br /> EH 23 041 ReVi sed 1/89 <br /> Administration mnlcal Servicos Environmental liaaith Public t-;oalth Nursing <br /> 488.3400 46a-38-10 468-3424 469-3880 <br /> Air Pollution community$4rvtcov Laboratory �yVIC <br /> 488-3470 468-3820 468-3460 4G$-32a4 <br /> AID$information 46$-3820 <br />